Preliminary study of total laparoscopic hysterectomy for the cases of very early cervical cancer or its precancerous state

Hirohiko Tanaka, Katsuhiko Ito, Yuki Minami, Masako Ito, Yoshinari Kobayashi, Miho Izawa, Tetsuo Asakura, Haruki Taniguchi, Kenji Nagao, Takashi Motohashi, Eiji Kondo
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2013 · vol. 29(1) , pp. 308–312 · doi:10.5180/jsgoe.29.308 · W2319616879
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This preliminary study demonstrates that total laparoscopic hysterectomy is a feasible and safe procedure for very early cervical cancer or precancerous states, requiring specific techniques distinct from those used for fibroids or adenomyosis.

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This study evaluated the feasibility and safety of total laparoscopic hysterectomy for patients with very early cervical cancer or precancerous states who require definitive surgical management. The researchers performed the procedure on nine patients using a diamond trocar configuration and manual uterine elevation with nylon thread, avoiding standard manipulators due to the specific anatomical challenges posed by prior conization or atrophy. All surgeries were completed successfully without conversion to open procedures or postoperative complications, with patients discharged on the fifth postoperative day. The authors noted that while lifting the uterus requires ingenuity compared to standard benign cases, the technique is viable despite limited visibility of incision sites. Relevance to endometriosis: adenomyosis is mentioned only as a comparative context for standard hysterectomy techniques where manipulators are typically used, whereas this paper focuses on cervical pathology.

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Abstract

Due to vaginal narrowing or cervical atrophy, it is sometimes difficult to safely perform conization in menopausal women. Total hysterectomy is recommended in patients with positive conization margins or cervical intraepithelial neoplasia who do not desire children. In such patients, we performed total laparoscopic hysterectomy (TLH) following approval from the Ethics Committee of our hospital. Nine patients underwent TLH between June 2010 and March 2012. TLH was performed using four trocars placed in a diamond configuration in the same manner as that for benign diseases. In principle, we did not use uterine manipulators, and lifted the uterus with a 2-0 nylon thread using a straight needle. When separating the bladder from the uterine cervix, a vaginal pipe was inserted. The ureter and uterine artery were identified first, and then the latter was ligated and cut. Total hysterectomy was performed with the extrafascial technique. None of the patients required conversion from laparoscopic to open abdominal hysterectomy, or underwent re-surgery due to complications, and all of them were discharged on the fifth postoperative day. Unlike when performing total hysterectomy for fibroids or adenomyosis, surgery is performed without the insertion of manipulators; therefore, we need to exercise some ingenuity to lift the uterus. Although TLH poses some problems in post-conization patients, such as "the site of incision is difficult to see even if a vaginal pipe is inserted," it can be performed with some ingenuity.
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Original article Preliminary study of total laparoscopic hysterectomy for the cases of very early cervical cancer or its precancerous state 2013 Volume 29 Issue 1 Pages 308-312 Details Abstract Due to vaginal narrowing or cervical atrophy, it is sometimes difficult to safely perform conization in menopausal women. Total hysterectomy is recommended in patients with positive conization margins or cervical intraepithelial neoplasia who do not desire children. In such patients, we performed total laparoscopic hysterectomy (TLH) following approval from the Ethics Committee of our hospital. Nine patients underwent TLH between June 2010 and March 2012. TLH was performed using four trocars placed in a diamond configuration in the same manner as that for benign diseases. In principle, we did not use uterine manipulators, and lifted the uterus with a 2-0 nylon thread using a straight needle. When separating the bladder from the uterine cervix, a vaginal pipe was inserted. The ureter and uterine artery were identified first, and then the latter was ligated and cut. Total hysterectomy was performed with the extrafascial technique. None of the patients required conversion from laparoscopic to open abdominal hysterectomy, or underwent re-surgery due to complications, and all of them were discharged on the fifth postoperative day. Unlike when performing total hysterectomy for fibroids or adenomyosis, surgery is performed without the insertion of manipulators; therefore, we need to exercise some ingenuity to lift the uterus. Although TLH poses some problems in post-conization patients, such as "the site of incision is difficult to see even if a vaginal pipe is inserted," it can be performed with some ingenuity. Nine patients underwent TLH between June 2010 and March 2012. TLH was performed using four trocars placed in a diamond configuration in the same manner as that for benign diseases. In principle, we did not use uterine manipulators, and lifted the uterus with a 2-0 nylon thread using a straight needle. When separating the bladder from the uterine cervix, a vaginal pipe was inserted. The ureter and uterine artery were identified first, and then the latter was ligated and cut. Total hysterectomy was performed with the extrafascial technique. None of the patients required conversion from laparoscopic to open abdominal hysterectomy, or underwent re-surgery due to complications, and all of them were discharged on the fifth postoperative day. Unlike when performing total hysterectomy for fibroids or adenomyosis, surgery is performed without the insertion of manipulators; therefore, we need to exercise some ingenuity to lift the uterus. Although TLH poses some problems in post-conization patients, such as "the site of incision is difficult to see even if a vaginal pipe is inserted," it can be performed with some ingenuity. © 2013 Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy Favorites & Alerts Recently viewed articles

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